Provider Demographics
NPI:1306104963
Name:HINMAN, JUDY ELLEN
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ELLEN
Last Name:HINMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 VIDLER RD
Mailing Address - Street 2:
Mailing Address - City:WEST EDMESTON
Mailing Address - State:NY
Mailing Address - Zip Code:13485-2933
Mailing Address - Country:US
Mailing Address - Phone:315-861-7696
Mailing Address - Fax:
Practice Address - Street 1:2705 VIDLER RD
Practice Address - Street 2:
Practice Address - City:WEST EDMESTON
Practice Address - State:NY
Practice Address - Zip Code:13485-2933
Practice Address - Country:US
Practice Address - Phone:315-861-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY507959-1163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology